Back pain in Athletes

Rajesh Rao, MDFAAPMR

Topics

• Anatomy• Incidence• Sports associated with back injury• Prevention • Treatment approach• Take Home message• Questions

Anatomy

• Structure of the Bones• Muscles• Ligaments• Disc• Facet joints

Bones

• 5 Lumbar Vertebrae• Sacrum• Discs in between the bones

Muscles

• Anterior (flexors)• Posterior (extensors)• Lateral (abdominals)

Back pain related to sports

• Repetitive stress• Acute injuries• Relations to specific sports

Incidence

• 5-8% of injuries in all sports• 15 % of spinal injuries ( all levels) in

US – related to sports and recreational activity.

• MusculoLigamentous injures of paraspinal muscles common causes in all sports involving Rotation

Incidence

• MusculoLigamentous injures of paraspinal muscles common causes in all sports involving Rotation.

• ( Golf Baseball Tennis)• Contact ( Basketball, football, soccer)• Repetitive injury mechanisms( gymnastics, swimming, diving,

volleyball)

Incidence

• Full contact sports – football and rugby common causes of spinal injury

• High speed sports such as down hill skiing and snowboarding

• Reported incidence of spinal injuries among snowboarders 3-4 times higher than Skiers.

• Jumping is responsible for 80% among snowboarders and affect the thoracolumbar spine.

Clinical syndromes

• Musculo-Ligamentous Injuries • Disc herniations• Fracture subluxations and dislocation• Osteoporotic fractures in elderly• SpondyloLysis and spondylolisthesis

( Extension based sports- Gymnastics, Cheerleading, Diving)

Evaluation

• Clinical Examination• X Rays• MRI• CT scan • Bone scan

Clinical Examination

• Important Clues pertaining to cause • Helps formulate a Plan of action• Important in determining any

Neurological involvement

X rays

• Important for Bone anatomy• Look for fractures or Subluxations

MRI

• Muscle and Ligamentous issues• Disc Hernations• Nerve compression• Stenosis

Bone Scan

• Sensitive test for Fractures and stress reactions

• Spondylolysis

CT scan

• Evaluation of new and old fractures

Treatment

• Prevention• Active treatment

Prevention

• Exercise program• Stretching program• Sport specific training

Getting F.I.T.depends on:

• Frequency (How often?)

• Intensity (How hard?)

• Time / duration (How long?)

Flexibility

• Stretching: especially HAMSTRINGS• Include all major muscle groups

Motion

• Range of motion and movement (Flexion and Extension Lateral motions)

• F: daily• I: easy• T: 2-15 minutes

Aerobic Conditioning

• More than walking, jogging or running• More than one way to get aerobic benefit

• 3-4 times per week• Atleast 20 minutes duration

Strengthening

• Key component of any good exercise program

• Even more important as we get older• Pain causes inhibition which leads to

weakness

Stabilization Exercises

Flexion Exercises

Treatment Approach

• Relative rest• Physical therapy• Anti-Inflammatory medications• Injection therapy• Surgical treatment

Physical Therapy

• Exercise program• Modalities ( Heat, Ice , Estim, TENS

unit)• ROM • Pain Modulation

Medications

• Limited use of the NSAIDS• Pain Medications• Muscle relaxants• Anti-inflammatory Steroids

Injection therapy

• Specific Conditions are amenable to injection therapy

• Epidural injections• Facet joint injections.

Surgical treatment

• Neurological Deficits• Instability• Persistent pain

Need to establish One to One relation between Symptoms and Pathology.

Overview of treatment approach

• Therapy- most useful for muscular issues

• Limited use of NSAIDS recommended• Injections useful for Pinched nerve and

facet joint issues• Surgery- useful in case of Neurological

deficit, instability.

Take Home Message

• Prevention is better than Cure• Low back pain is amenable to

conservative treatment.• Evaluation needed for specific

conditions e.g Spondylolisthesis• Small percent of cases need surgical

treatment.

Questions